Current Life Situation Research Articles

Reproductive health care for asylum-seeking women - a challenge for health professionals.

BackgroundDealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO) and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients.MethodsA mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory.ResultsThe principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population), due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient.ConclusionHealth policies for asylum seekers need to be designed to assure access to adequate contraception, and to provide psychological care for this vulnerable group of patients. Care for asylum seekers may be emotionally very challenging for health professionals.

Compensation: Architecture for supporting dynamicity and negotiation in accounting, charging and billing

As of today, contractual agreements govern the terms of interaction between users and providers as well as between interoperating providers. Such contracts indicate usable services and resources, tariffs, payment methods, etc. Typically, these terms are negotiated once before the contract is signed and are seldom changed thereafter, such that contracts are rather static and inflexible. Furthermore, establishing such a contract requires human involvement. As a consequence, it is difficult for small content or access providers to reach users and to find interoperation partners amongst the large operators. In addition, providers in general lack flexibility with respect to charging according to demand, and users are unable to easily change their preferred access and service conditions depending on their current life situation and location. Supporting automated and dynamic negotiation of contractual agreements as well as implementing these agreements in an automated, ad hoc fashion are therefore key requirements for compensation systems in future mobile networks. In this paper we propose a functional compensation architecture that meets these key requirements. The architecture is furthermore designed to be able to operate atop of current compensation systems and thus protects and even leverages prior investments. Finally, the architecture allows for the integration of different legacy and non-legacy compensation-related components and thus supports heterogeneous systems. The description of the conceptual architecture in this work is complemented by presenting a prototype including first performance indicators.

Preface: Biography and Ethnicity: Development and Changes in Senses of Socio-cultural Belonging in Migrant Populations in the US and Germany

This special issue is based on the empirical research carried out for our project Biography and Ethnicity: Development and Changes in Senses of Socio-cultural Belonging in Migrant Populations in the United States and This research and collaborative teaching project at the School of Humanities and Social Sciences at Nova Southeastern University (USA) and at the Center of Methods in Social Sciences, Faculty of Social Sciences at Georg-AugustUniversity of Gottingen (Germany) between 2006 and 2008 was characterized by a differing methodological and interdisciplinary approach. Whereas the US-team of researchers followed a psychological and social-anthropological approach, the team of researchers from Germany consisted of sociologists. The German team primarily conducted biographical-narrative interviews, while the team in Florida applied participant observation techniques in addition to biographical and openended interviews. The persons belong to different groupings of migrants who have settled in Germany and the United States in order to escape socio-political ethnic conflicts or difficult living conditions in their countries of origin, whereby most of these immigrants may be considered political refugees. The goal of our study was to investigate the processes behind the creation and transformation of ethnic belongings and, in general, collective belongings of various groupings of migrants in variant social contexts. In particular, we examined how different living conditions and different societal contexts influenced the development and transformation of the sense of collective belonging. [1] Interviews were conducted with migrants from Guatemala, Haiti, and Cuba now living in South Florida as well as migrants from Cuba, Poland, Iran, Sierra Leone, Ghana, and the successor states of former Yugoslavia and the former Soviet Union now living in Germany. This special issue will introduce the theoretical and methodological considerations as well as the empirical findings of the US and German research teams. The articles reflect upon and compare the interrelated life courses and current life situations of these different groupings of migrants. [2] This special issue also includes an article by Alex STEPICK and Carol DUTTON STEPICK who were kind enough to contribute an article describing their research dedicated to the same or very similar themes. For many years, these researchers have made migration to South Florida the focus of their work. Their article focuses on migrants' experiences in the country of immigration and describes the coexistence between the established residents and newcomers from Cuba, Haiti, and other Caribbean and Latin American countries. The following chapter, an

Don’t Raise the Retirement Age! An Experiment on Opposition to Pension Reforms and East-West Differences in Germany

For policy reforms to increase a society's welfare, reliable information on people's preferences and expectations is crucial. Representative opinion polls, often involving simplified questions about the complex topics under debate, are an important source of information for both policy-makers and the public. Do people's answers to these poll questions reliably reflect their preferences and expectations, or does fundamental, undiscriminating opposition to reforms distort them? We address this question in the context of a recent German pension reform which raised the statutory retirement age by two years to age 67. By introducing an experiment into a representative household survey, we are able to disentangle expectations of work ability at retirement and fundamental opposition. Our results show that expected work ability declines substantially with increasing target age (63, 65, or 67 years). Answers from West German respondents re°ect their current life situation as well as individual health nd other risk factors. However, a fundamental opposition to reforms of the welfare state appears to strongly affect responses from East German households.

Don't Raise the Retirement Age! An Experiment on Opposition to Pension Reforms and East-West Differences in Germany

For policy reforms to increase a society's welfare, reliable information on people's prefer-ences and expectations is crucial. Representative opinion polls, often involving simplified questions about the complex topics under debate, are an important source of information for both policy-makers and the public. Do people's answers to these poll questions reliably reflect their preferences and expectations, or does fundamental, undiscriminating opposition to reforms distort them? We address this question in the context of a recent German pension reform which raised the statutory retirement age by two years to age 67. By introducing an experiment into a representative household survey, we are able to disentangle expectations of work ability at retirement and fundamental opposition. Our results show that expected work ability declines substantially with increasing target age (63, 65, or 67 years). Answers from West German respondents reflect their current life situation as well as individual health and other risk factors. However, a fundamental opposition to reforms of the welfare state appears to strongly affect responses from East German households.

Backyard living: integrative policies towards migrant workers ; housing microfinance in greater Ho Chi Minh City, Vietnam

The urban agglomeration of the Vietnamese southeast industrial driving force Ho Chi Minh City (HCMC) has become the most outstanding benefi ciary of the remarkable economic growth and foreign investments in the Vietnamese economy since the start of a comprehensive economic reform process in the mid 1980s. The notable development towards the foremost economic centre led to a high infl ux of migrant workers. In the course of an ongoing expansion process towards a megacity of tomorrow, the defi cient provision of adequate housing remains one of the most challenging problems of rural migrants in Greater HCMC. However, a future-oriented sustainable megacity concept is strongly dependent on the successful integration of migrants into the urban society. Within this context, the housing market is considered to be a key aspect of comprehensive urban planning. Hereby, housing microfi nance (HMF) will be presented as an alternative housing finance scheme meeting the demand of a noteworthy number of poor and low-income people. Thereby HMF can do both: focus on specifi c needs of migrants with respect to their current life situation and enhance its outreach to a potential target group.

Life situation and quality of life in young adult kidney transplant recipients

Young adults, 18-35 years of age, may be more vulnerable to chronic diseases than other age groups. In this study we describe the life situation and lifestyle of young adult kidney transplant recipients and compare their health-related quality of life (HRQoL) with a general population sample. Questionnaires, including items on life situation, lifestyle, and the SF-36 HRQoL questionnaire, were mailed to all 280 renal transplant recipients in Norway between 18 to 35 years of age at the time of investigation of whom 131 (47%) responded. For comparison, we used 2,360 respondents aged 18 to 35 years from a general population survey in one Norwegian county. SF-36 scores are presented with unadjusted scores and the mean difference between groups adjusted for age, sex and education using multiple linear regression analysis. The kidney transplant recipients reported high participation rates in cultural and sports activities, and the majority of them were satisfied with their work. A larger proportion of the transplant recipients had attained university education than the general population sample. However, 25% of the total group were not integrated in professional life. The transplant recipients scored lower than the general population on seven of the eight SF-36 scales and the two summary scales after adjusting for age, sex and education. The majority of young adult kidney recipients aged 18-35 years were well adapted in their family and professional life and satisfied with their current life situation. However, in aggregate they reported lower HRQoL on most scales of the SF-36 than a general population sample.

Problem Behaviors of Homeless Youth: A Social Capital Perspective

Homeless youth are one of the most marginalized groups in our society. Many researchers identify much higher levels of various problem behaviors among these youth compared to their non-homeless peers. The current study examined the utility of social capital in predicting problem behaviors among homeless youth. Overall, the theoretically derived social capital variable significantly predicted substance use frequency, sexual risk behavior, depression, delinquent behavior as well as number of days homeless. Thus, social capital was useful in understanding and predicting the current life situation among these youth and may be worthy of further study. Findings suggest that meaningful change should utilize interventions that go beyond the individual and are geared towards modifying the social context of individuals' lives.

Das Ergotherapeutische Assessment - Praktikabilität, inhaltliche Validität und interne Konsistenz des Selbsteinschätzungsbogens für Alltagstätigkeiten

Einleitung: Der neue Selbsteinschätzungsbogen für Alltagstätigkeiten bei Ergotherapieklienten im arbeitstherapeutischen Bereich basiert auf dem validierten und etablierten Ergotherapeutischen Assessment. Seine Verständlichkeit und Akzeptanz bei erwachsenen, nicht ergotherapeutisch behandelten Probanden wurden bereits in einer Pilotstudie analysiert. Diese Studie untersucht die Praktikabilität, inhaltliche Validität und interne Konsistenz des Selbsteinschätzungsbogens.

Parental Physical Illness as a Risk for Psychosocial Maladjustment in Children and Adolescents: Epidemiological Findings From a National Survey in Germany

The authors assessed the risk for psychosocial maladjustment in a population-based sample of dependent children of parents with serious physical illness. In the context of The Hamburg Health Survey, a wide range of data on current life situation and health status was collected from a representative sample of families with children and adolescents between 4 and 18 years old (N=1,950). For 4- to 18-year-old children and adolescents in Germany, the prevalence of a serious physical illness in a parent was 4.1%. The adjusted risk of psychosocial maladjustment in this target group, depending on the case definition, is elevated, with internalizing problems being more prevalent than externalizing problems. Although problems for affected boys decline with puberty, they increase for girls. In this age-group, girls and boys appear to be under particular strain when the respective same-sex parent has a serious physical illness. Exposure to serious parental physical illness is an epidemiologically relevant risk factor for psychosocial maladjustment in children and adolescents that needs to be better recognized by medical professionals.

Women’s Views of Caring for Family Members: Use of Respite Care

The purpose of this study was to describe the life situation of informal caregivers who regularly use respite services when caring for their older relative. The sample consisted of 17 wife and daughter caregivers who frequently relied on respite care to support coping at home. Data were analyzed by inductive content analysis. Spousal caregivers in a warm, loving relationship or who longed for their lost relationship with a husband experiencing a memory disorder did not identify themselves as informal caregivers, but principally as wives. Periods of respite invoked feelings of emptiness; on the other hand, they offered an opportunity for these caregivers to take care of their own health. The younger spouses also felt it was a relief to have time for their own interests. Caregivers who felt that being with the care recipient was an obligation described their relationship as mainly caregiving. In relationships focusing on organizing the daily routines, caregivers welcomed respite as a relief but experienced unexpected feelings of guilt. Those who felt imprisoned by the care recipient relied on respite to help them cope with a burdensome relationship, while waiting for their loved one's transfer into permanent institutional care. The results of the study challenge health care professionals to commit themselves to family-centered work, in which knowing the family's history and current life situation is key to providing high-quality services.

Assessing Grief and Bereavement: Observations from the Field

The purpose of this article is to describe the evaluations involved in the Yale Bereavement Study (YBS), a three-year NIMH and NCI-funded longitudinal study conducted from January 2000 through May 2003. The quantitative and qualitative questions included in the YBS gave the respondents an opportunity to describe their most recent loss, rate and review their past losses, and assess all aspects of their current life situations. In this article, the first author describes, in a qualitative manner, the ways in which this assessment, per se, appeared helpful and not harmful to the respondents. Also, developed here is the implication for potential application of a modified version of the YBS which could be used in both research and clinical practice.

Viajando con Don Quijote en el siglo XXI

El Quijote ha cabalgado con nosotros por largo tiempo y como si no fuera suficiente la lucha contra los molinos de viento, don Quijote de la Mancha tendrá que luchar contra muchas situaciones de nuestra época actual. ¿Logrará esta hazaña el Caballero de la Triste Figura? El reto es dar la respuesta.
 Por tal motivo, la autora de este ensayo traslada al Caballero de la Triste Figura y lo inserta a la sociedad del siglo XXI. Transforma los valores, costumbres y puntos de vistas de la época en que se desarrolla la obra literaria y establece una serie de correlaciones entre el texto literario, el personaje principal y las diversas situaciones cotidianas actuales. Ciertamente, Don Quijote seguirá luchando contra las situaciones de nuestra época actual. Sin duda alguna este hidalgo está aún entre nosotros.

Lebenszufriedenheit transsexueller Patienten nach geschlechtsangleichenden Operationen

More and more frequently, the registration of life satisfaction is being used to evaluate different medical treatments. So far, there have been only few such surveys on transsexuals (TS). Therefore, the aim of this study was to evaluate the general and the health-related life satisfaction of transsexuals after gender transformation operations. Forty patients took part in this German cross-sectional study. The Questions on Life Satisfaction Module (FLZ) and free questions on different aspects of the new gender identity were used as measuring instruments. Of the TS studied, 85-95% were "very satisfied" or "satisfied" with the results of their gender transformation operation in respect to gender identity. The TS were significantly less satisfied (P>0.001) in overall "general life satisfaction" than the general population. In overall FLZ scores for "health-related life satisfaction", no differences were seen. These data indicate a discrepancy between subjective satisfaction with new gender identity and current life situation, and they identify problems with life satisfaction.

Breast Cancer: A Manual for a Proposed Group Treatment Integrating Evidence Based Resilience Factors

The paper presents the structure and content of a manual for a proposed treatment of breast cancer patients in groups. The proposed treatment is structured, time limited, and integrates elements from 1995 work of Spiegel and the Yalom 1995 theory of group therapy as well as empirically derived resilience factors. Addressing the psychological specificity of breast cancer, the overall treatment goals are to help patients to acquire new coping skills for relieving stress, to increase their personal and social competence and their use of available social support, to increase family coherence, to enhance optimism and quality of life, and to help patients develop new values and priorities that comply with their current and future life situation.

The role of verbal conditioning in third generation behavior therapy.

Kohlenberg, Boiling, Kanter & Parker (2002) and Hayes (2004) have argued that a third generation has occurred in behavior therapy. Hayes (2004) states the movement is characterized by several factors. These factors are, it: (a) is grounded in empirical principles; (b) has a contextual and experiential focus giving priority to function of behavior versus form; (c) emphasizes issues relevant to clinicians and clients; (d) synthesizes previous generations of behavior therapy into the present form; and (e) deals with the questions raised from other traditions. To this end, this article reviews the literature on the role of verbal conditioning in the counseling and consulting process. This literature holds the key to dealing with many challenges that currently face behavior therapists working from a constructional perspective in their attempts to construct a helping process. In a particular, verbal conditioning could hold a central role in reducing unfavorable outcomes in psychotherapy and in answering questions of recovered memories. Key words: third generation behavior therapy, conditioning, therapeutic relationships ********** Behavior therapy is witnessing a small revolution in thinking as the second generation of behavior therapy slowly gives way to the third generation (Kohlenberg, Boiling, Kanter & Parker, 2002; Hayes, 2004) (1). The third generation of behavior therapy is based more on contextual thinking and case conceptualizations. From the behavior analytic tradition, several approaches are central to the third generation of behavior therapy. These are (a) acceptance and commitment therapy (ACT) (Hayes, Strosahl, & Wilson, 1999) (b) behavioral activation (BA) (Martell, Addis, & Jacobson, 2001) (c) Functional Analytic Psychotherapy (FAP)(Kohlenberg & Tsai, 1991) and (d) Integrative Behavioral Couples Therapy (IBCT) (Jacobson & Christensen, 1996). Most will acknowledge that these new therapies have core differences; however, Hayes (2004) has presented five factors that critically define the third generation of behavior therapy. These are it is (a) grounded in empirical principles; (b) has a contextual and experiential focus, giving priority to function of behavior versus form; (c) emphasizes issues relevant to clinicians and clients; (d) synthesizes previous generations of behavior therapy into the present form; and (5) deals with the questions raised from other traditions. Many factors have given rise to the new wave in behavior therapy (2). The rise of these therapies may be in part due to the perceived equivalence in psychotherapies (see Gifford, 2002); however, the meta-analysis that originally hinted at equivalence is seriously flawed both statistically and procedurally (see Cautilli & Skinner 2001). Another reason for the third generation might be persistent failures in outpatient cognitive therapies to produce more lasting or intensive clinical gains (Kanter, Cautilli, Busch, & Baruch, 2005). It is more likely that behavior and cognitive therapies representing the two dominant empirical approaches to psychotherapy engage in a continuous dialectical dance, each solving problems, creating models, and in turn offering innovations. As time goes on, they integrate, depart, challenge each other's models of phenomena, answer new questions, and reintegrate. Third generation behavior therapy is beginning to receive growing empirical support for both its models of psychopathology and its technologies for treatment (see Hayes, Masuda, Bissett, Luoma, & Guerrero, 2004). Behavior therapy is a dynamic and creative process. Each client presents a new challenge because clients differ in genetics, behavioral histories, current life situations, desires, goals, values, and needs. Each relationship between therapist and client calls for the use of flexible skills to create the helping relationship (Williams, 2002). Creation of or the building of skills and not simply the elimination of behavior problems is the central core value of behavior therapy (Goldiamond, 1974). …

Resource optimisation at a clinical counselling facility for hereditary breast cancer: Why do eligible patients decline result disclosure following BRCA1 gene analysis?

9597 Background: In Austria, molecular-genetic testing for BRCA1 and BRCA2 is conducted in a clinical setting but financed via research funds. To ensure the optimal use of limited resources, we determined the number of patients who declined to learn their BRCA1 test result after initially opting for molecular-genetic testing. Our report investigates these patients' characteristics and motives. Methods: The study included 552 patients from 280 families eligible for molecular-genetic testing. It was evaluated if patients, after pre-test counselling, decided for or against genetic testing, respectively if they opted for or against result disclosure following genetic testing. Socio-demographic, clinical, and family-related data were used as predictors for patients' decision. Motives for declining result disclosure were assessed by a custom-designed questionnaire. Results: Test result disclosure was declined by 107 patients (19%). Twelve percent of decliners (n = 13) opted for result disclosure after receiving the questionnaire. Male patients (OR = 4.24, P < .001) and patients who underwent abbreviated counselling (OR = 3.73, P < .001) were less likely to opt for disclosure. The same tendency applied to patients without daughters (OR = 1.51, P = .08). Motivational analysis revealed that some patients decided against result disclosure owing to their current distressed life situation. Conclusions: For men and patients without daughters, pre-test counselling should include a particularly thorough investigation of the motives underlying the decision for BRCA testing. Patients declining result disclosure owing to their distressed life situation should be actively contacted again later. An abbreviated pre-test counselling session appears inadvisable. No significant financial relationships to disclose.

Continuing care of chronic illness: Evidence-based medicine and narrative-based medicine as competencies for patient-centered care

The longitudinal care of patients with chronic illnesses is one of the most central respon- sibilities of a family physician's practice. To the patient-physician relationship, the patient brings his needs - arising from his prior life experiences, current life situation, resources, and explanatory models of illness. The physician brings expertise and evidence about the best care for the disease. The bridge connecting these two worlds is narrative-based medicine (NBM). An essential competency for the best care of patients with chronic illness is an amalgamation of evidence-based medicine (EBM) and NBM, based upon an underlying infrastructure of behavioral science. Although such knowledge, skills, and attitudes are essential, the very best longitudinal care develops over time and requires careful obser- vation by physicians. © 2003 Blackwell Publishing Asia and Wonca

The Human Mind: Building Bridges between Neuroscience and Psychiatry

This essay proposes the existence of four unique behavioral characteristics that distinguish Homo sapiens from its nearest evolutionary kin, the great apes. These are inventiveness, capacity for language, curiosity, and self-reflection or self-analysis. Some would counterargue that none of these features are "unique" to humans. Examples would be given of animal "intelligence" involving at times surprising problem-solving abilities. Even "conversations" between humans and parrots might be cited. However, this is to misunderstand what the focus is in the article. This is not a thesis on the continuity or discontinuities of evolution. Every well-trained biologist learns about evolution and understands that the most complex human traits have some hint of related traits in nearest relatives. Rather, the emphasis of this article has been to select and emphasize certain distinctive aspects of human behavior that are the most important features distinguishing human "uniqueness." Uniqueness may be quantified by the number and complexity of processes within the four attributes presented in this article. While this may be an interesting mathematical exercise, the author would rather take it for granted that the outcome would be that humans are significantly more complex in each of the four features referred to than the great apes. For those in the mental health field, one would hope that this overview of the most highly evolved systems in human brain may provide a useful framework where creative therapeutic processes can be applied to the ultimate beneficiary, the client or patient. This article proposes that psychosis can be considered the impossibility of conflict resolution among the special neuronal assemblies that separately mediate feelings of attachment versus abandonment, security versus anxiety, calmness versus anger, fulfillment versus helplessness, and satisfaction of sexual needs. Given this model, the role of the therapist is to consider whether the client is in touch with the various equilibrium points in their current life situation or crisis. A questionnaire designed to help access information on these internal states may work better than an oral interview because it forces the client to reflect. How much conflict does the client feel in sorting out personal priorities? Does the client have any practice at resolving internal conflicts? If unpracticed, is the client likely to act out in destructive ways to self or others to resolve the pressure of internal conflicts? I am sure that we can all think of current well-publicized destructive acts in which one has to wonder precisely what model of mind the psychotherapists were using to assist the client. At a higher level, each human has the potential to be creative. Whether expressed as curiosity about the universe and nature or inventiveness, as in improving the quality of one's life or by the use of gifted language as in art and music, the therapist needs to determine how to assist the client into these kinds of self-defined fulfillments, which one hopes will reduce the other tensions of conflict resolution. There is no doubt that the journey for both the client and therapist will be challenging. Ultimately, the journey is the reward for both the client and therapist. In closing, the following quotation seems appropriate. Sydney Brenner (2002), a pioneer in molecular biology, reviewed a current book on the Science, Politics, and Ethics of the Human Genome Project (Sulston and Ferry 2002). He states, "What I found interesting in the account is that Sulston doesn't tell us anything about the genomes he has sequenced. What did he find there that excited him? What did he learn about genes, about life, about evolution, about worlds to come? It is the play of Hamlet without Hamlet" (p. 794).

Proximal and Distal Influences on Development: The Model of Developmental Adaptation

Theories of stress and adaptation in adulthood typically focus on recent influences on developmental change. What needs more attention in developmental studies is a stronger emphasis on the relationship between proximal and distal experiences in explaining developmental outcome. To address the need for combining past with present influences, we present a model of developmental adaptation that explains the process of adaptation to life stress on the basis of adverse childhood events and paternal care during childhood and internal and external resources available for adaptation to current life events. The appraisal of past and current events, as well as coping behaviors, are hypothesized to influence the health and well-being of individuals. The benefit of this model is that it systematically combines biographic (“distal”) variables with the current life situation (“proximal influences”) in an effort to explain developmental changes across the life span.